OBITUARY
Sir Charles Symonds Sir Charles Symonds, honorary member of the American Neurological Association siilce 1947, died in London on December 7, 1978, after a long illness. Until his retirement from the National Hospital for Nervous Diseases in London (“Queen Square”) he had been for many years the most esteemed and respected teacher of American postgraduate students receiving part of their training at that institution. In English neurology he inherited the mantle of Gowers and Gordon Holmes in the great tradition of bedside teaching. He disdained the showmanship of Collier and Kinnier Wilson to large audiences. His many publications are exemplary in their meticulous clinical descriptions and close analysis of symptomatology, pursued to clinicopathological correlation when possible. Charles Putnam Symonds was born in 1890, the son of Sir Charters Symonds, a prominent London surgeon who was descended from a loyalist family that fled from Massachusetts to New Brunswick following the success of the American Revolution. Charles was a medical student at the outbreak of World War I and immediately enlisted as a dispatch rider in the British Army, serving in the battles of the Somme and Marne until wounded. O n recovery he was sent to complete his medical education. O n his return from further military service, Symonds became a resident at the National Hospital, Queen Square, London, where he was greatly influenced by Gordon Holmes and Kinnier Wilson and the pathologist Godwin Greenfield. In 1920 he received a staff appointment at Guy’s Hospital and Medical School, in the southeast sector of London, founded in 1725 and famous as the institution that had fostered the classic work of Richard Bright, Thomas Addison, and Thomas Hodgkin. Another of its famous physicians, Samuel Wilks, published the first English textbook of neurology in 1878. Neurological medicine had been, in London as elsewhere, a special interest of general physicians, and the patients were housed in general wards. When Symonds was appointed Physician for Diseases of the Nervous System in Guy’s Hospital, with special bed service and with a resident and outpatient clinic, his was the first such complete unit in a general hospital in Britain. The appointment was also notable in that it included responsibility for psychological medicine, which was then still considered to belong to the province of neurology. At the same time Symonds was awarded a traveling fellowship to the United States to visit the Phipps Clinic at the Johns Hopkins Hospital (Adolf Meyer) and the Brigham Hospital in Boston (Harvey Cushing) for a year. His training with Meyer gave him unusual insight into psychological problems; that with Cushing, a unique view of living pathology. H e was thus well equipped for the double challenge represented by the Guy’s Hospital position. The department became an enormous success, and the pressure of outpatients eventually led to the appointment of a psychiatrist (Gillespie) in 1934. Symonds’ assistants in neurology were Denny-Brown and later McArdle. His visit to the Brigham led to publication of the account of a patient who died of ruptured berry aneurysm in Cushing’s clinic, in whom Symonds’ diagnosis in life of intracranial aneurysm had been received with extreme skepticism
by Cushing. When the aneurysm was later disclosed, Cushing insisted that Symonds report the case, which he did in 1923, with 4 additional cases and a note by Cushing. Aneurysm as an autopsy finding had been reported before (including 4 cases by Wilks from Guy’s Hospital in l859), but Symonds’ report was the first to draw attention to the possibility of correct diagnosis during life. He made a masterly review of the subject the following year. In 1924 he also published a classic account of the micropathology of multiple sclerosis, and in the next ten years a series of clinical studies on a variety of subjects, particularly o n complications of intracranial suppuration, Schilder’s encephalopathy, Charcot-Marie-Tooth disease, high spinal compression, and the importance of early recognition of affective disorder. In 1926 Symonds secured an appointment as assistant visiting physician (lowest rung o n the staff ladder) at the National Hospital for Nervous Diseases. It should be pointed out that these hospital appointments at Guy’s and at the National Hospital were, until after World War 11, purely honorary, the incumbent being expected to earn his living in private practice. By 1935 Symonds had become interested in the complications of head injury, particularly differentiation of true memory and attention defects from psychoneurotic changes. These studies were to take on considerable importance when he was given the responsibility for dealing with Royal Air Force casualties in World War 11. As Group Captain in the RAF and eventually Air Vice Marshal, he organized a distinguished group of neuropsychiatrists to concentrate on the problems of head injury and flying stress in aviators. Together with the neurosurgeon Hugh Cairns, he set up a combined army and air force service hospital for special treatment of the effects of head injury, where a number of young neurologists received vital wartime training. Papers on the neurological approach to mental disorder (1941) and sequelae of head injury (1941, 1942, 1945) and his lectures on flying stress (Dunham Lectures at Harvard, 1943) resulted from this experience. He was knighted in 1946 and received other honors for his military services. Following the war he returned to Guy’s Hospital, Queen Square, and private practice, continuing to publish original clinical studies o n various types of headache and migraine, epilepsies and myoclonus, memory defect, and occlusion of carotid arteries. In 1970, having retired from his hospitals, he published an attractive volume of selected reprints of his most important papers, with lively autobiographical introduction, that is in its way a classic of clinical reporting (Studies in Neuro/og.y, Oxford University Press). The papers well repay rereading, and for the young physician in training, reveal many nuances of clinical neurology. Sir Charles bore a number of family misfortunes and a long terminal illness with enormous fortitude and resilience. His many friends mourn the loss of this outstanding neurologist, wise advisor, and staunch, magnanimous colleague.
D. Denny-Brown, M D
137
Sir Charles Symonds Sir Charles Symonds, honorary member of the American Neurological Association siilce 1947, died in London on December 7, 1978, after a long illness. Until his retirement from the National Hospital for Nervous Diseases in London (“Queen Square”) he had been for many years the most esteemed and respected teacher of American postgraduate students receiving part of their training at that institution. In English neurology he inherited the mantle of Gowers and Gordon Holmes in the great tradition of bedside teaching. He disdained the showmanship of Collier and Kinnier Wilson to large audiences. His many publications are exemplary in their meticulous clinical descriptions and close analysis of symptomatology, pursued to clinicopathological correlation when possible. Charles Putnam Symonds was born in 1890, the son of Sir Charters Symonds, a prominent London surgeon who was descended from a loyalist family that fled from Massachusetts to New Brunswick following the success of the American Revolution. Charles was a medical student at the outbreak of World War I and immediately enlisted as a dispatch rider in the British Army, serving in the battles of the Somme and Marne until wounded. O n recovery he was sent to complete his medical education. O n his return from further military service, Symonds became a resident at the National Hospital, Queen Square, London, where he was greatly influenced by Gordon Holmes and Kinnier Wilson and the pathologist Godwin Greenfield. In 1920 he received a staff appointment at Guy’s Hospital and Medical School, in the southeast sector of London, founded in 1725 and famous as the institution that had fostered the classic work of Richard Bright, Thomas Addison, and Thomas Hodgkin. Another of its famous physicians, Samuel Wilks, published the first English textbook of neurology in 1878. Neurological medicine had been, in London as elsewhere, a special interest of general physicians, and the patients were housed in general wards. When Symonds was appointed Physician for Diseases of the Nervous System in Guy’s Hospital, with special bed service and with a resident and outpatient clinic, his was the first such complete unit in a general hospital in Britain. The appointment was also notable in that it included responsibility for psychological medicine, which was then still considered to belong to the province of neurology. At the same time Symonds was awarded a traveling fellowship to the United States to visit the Phipps Clinic at the Johns Hopkins Hospital (Adolf Meyer) and the Brigham Hospital in Boston (Harvey Cushing) for a year. His training with Meyer gave him unusual insight into psychological problems; that with Cushing, a unique view of living pathology. H e was thus well equipped for the double challenge represented by the Guy’s Hospital position. The department became an enormous success, and the pressure of outpatients eventually led to the appointment of a psychiatrist (Gillespie) in 1934. Symonds’ assistants in neurology were Denny-Brown and later McArdle. His visit to the Brigham led to publication of the account of a patient who died of ruptured berry aneurysm in Cushing’s clinic, in whom Symonds’ diagnosis in life of intracranial aneurysm had been received with extreme skepticism
by Cushing. When the aneurysm was later disclosed, Cushing insisted that Symonds report the case, which he did in 1923, with 4 additional cases and a note by Cushing. Aneurysm as an autopsy finding had been reported before (including 4 cases by Wilks from Guy’s Hospital in l859), but Symonds’ report was the first to draw attention to the possibility of correct diagnosis during life. He made a masterly review of the subject the following year. In 1924 he also published a classic account of the micropathology of multiple sclerosis, and in the next ten years a series of clinical studies on a variety of subjects, particularly o n complications of intracranial suppuration, Schilder’s encephalopathy, Charcot-Marie-Tooth disease, high spinal compression, and the importance of early recognition of affective disorder. In 1926 Symonds secured an appointment as assistant visiting physician (lowest rung o n the staff ladder) at the National Hospital for Nervous Diseases. It should be pointed out that these hospital appointments at Guy’s and at the National Hospital were, until after World War 11, purely honorary, the incumbent being expected to earn his living in private practice. By 1935 Symonds had become interested in the complications of head injury, particularly differentiation of true memory and attention defects from psychoneurotic changes. These studies were to take on considerable importance when he was given the responsibility for dealing with Royal Air Force casualties in World War 11. As Group Captain in the RAF and eventually Air Vice Marshal, he organized a distinguished group of neuropsychiatrists to concentrate on the problems of head injury and flying stress in aviators. Together with the neurosurgeon Hugh Cairns, he set up a combined army and air force service hospital for special treatment of the effects of head injury, where a number of young neurologists received vital wartime training. Papers on the neurological approach to mental disorder (1941) and sequelae of head injury (1941, 1942, 1945) and his lectures on flying stress (Dunham Lectures at Harvard, 1943) resulted from this experience. He was knighted in 1946 and received other honors for his military services. Following the war he returned to Guy’s Hospital, Queen Square, and private practice, continuing to publish original clinical studies o n various types of headache and migraine, epilepsies and myoclonus, memory defect, and occlusion of carotid arteries. In 1970, having retired from his hospitals, he published an attractive volume of selected reprints of his most important papers, with lively autobiographical introduction, that is in its way a classic of clinical reporting (Studies in Neuro/og.y, Oxford University Press). The papers well repay rereading, and for the young physician in training, reveal many nuances of clinical neurology. Sir Charles bore a number of family misfortunes and a long terminal illness with enormous fortitude and resilience. His many friends mourn the loss of this outstanding neurologist, wise advisor, and staunch, magnanimous colleague.
D. Denny-Brown, M D
137
